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- Title
Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study.
- Authors
Pyrgidis, Nikolaos; Schulz, Gerald Bastian; Stief, Christian; Blajan, Iulia; Ivanova, Troya; Graser, Annabel; Staehler, Michael
- Abstract
Simple Summary: Studies about the current trends in renal cancer surgery and its perioperative outcomes are lacking. Using the nationwide data of Germany from 2005 to 2021, we found that the utilization of partial nephrectomy substantially increased, while the utilization of radical nephrectomy substantially decreased in the last years. Patients selected for radical nephrectomy had more comorbidities and risk factors compared to patients selected for partial nephrectomy. Our analyses suggest that patients undergoing radical nephrectomy present worse perioperative morbidity and mortality, as well as prolonged hospitalization, compared to patients undergoing partial nephrectomy. Background: We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005–2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses. Results: Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9, p < 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2, p < 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862, p < 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion (p < 0.001), sepsis (p < 0.001), acute respiratory failure (p < 0.001), acute kidney disease (p < 0.001), acute thromboembolism (p < 0.001), surgical wound infection (p < 0.001), ileus (p < 0.001), intensive care unit admission (p < 0.001), and pancreatitis (p < 0.001). Conclusions: More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.
- Subjects
PERIOPERATIVE care; LENGTH of stay in hospitals; NEPHRECTOMY; CONFIDENCE intervals; MULTIPLE regression analysis; TREATMENT effectiveness; RISK assessment; DESCRIPTIVE statistics; ODDS ratio
- Publication
Cancers, 2024, Vol 16, Issue 1, p97
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16010097